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Education Reporter

Drugging Kids Poses Myriad Risks
Ritalin Slows Growth; Prozac Problems
The trend toward using drugs to solve children's emotional and disciplinary as well as medical problems is yielding new information on the downsides of Ritalin, antidepressants and the chickenpox vaccine.

Stimulants like Ritalin used for attention deficit hyperactivity disorder (ADHD) may stunt children's growth, according to a new study of 540 youngsters aged 7 to 9. The children who took stimulants during the two-year study grew more than half an inch less and weighed more than 8 pounds less than those who were not medicated. It is not known whether the growth delays are temporary or permanent.

The study, which appeared in the April issue of Pediatrics, was led by University of California-Berkeley researcher Stephen Hinshaw and funded by the National Institute of Mental Health. ADHD is estimated to affect 4% to 12% of U.S. school-age children. (Associated Press, 4-5-04)

FDA acts on antidepressants 
The Food and Drug Administration in March requested that the makers of 10 antidepressant drugs place more explicit warnings on the labels for their medicines, asking doctors, families and caregivers to watch closely for signs of increasing depression or suicidal thinking. The move came a month after an advisory committee urged the FDA to provide clearer warnings about the possible risk of suicidal tendencies in children and adolescents taking antidepressants. The FDA's latest action includes adults as well.

Versions of Prozac, Wellbutrin, Paxil, Effexor and Zoloft are affected by the FDA's request for voluntary relabeling. The agency plans to continue to gather data on the link to suicide risk, which has not been conclusively established.

The suicide issue was first raised last year by regulators in Britain, who declared non-Prozac antidepressants unsuitable for depressed youth. Last October, the FDA warned doctors to watch for suicidal thinking and suicide attempts among adolescents and children taking any of a number of antidepressants. (See Education Reporter, Feb. 2004.) Parents subsequently gave emotional testimony to an FDA advisory panel concerning cases such as a 13-year-old boy who hanged himself in his bedroom closet after taking his seventh Zoloft.

The drugs may cause agitation, anxiety and hostility in some young patients who may be unusually prone to rare side effects, the FDA concluded. Some doctors theorize that antidepressants relieve the lethargy of depression before they relieve the feeling of hopelessness, making the patient more likely to take drastic action.

The rate of diagnosis of depression in children and adolescents more than doubled from the early 1990s to 2001, and the rate of antidepressant prescriptions for them more than tripled, according to statistics presented to a recent American Psychiatric Association convention in New York. A resolution will be presented to the American Medical Association meeting in June calling for federal regulators to allow access to unpublished studies by pharmaceutical companies, which could contain more negative information than has previously been made public. (Wall Street Journal, 5-5-04)

Children aged 5 and younger are the fastest-growing segment of the youth population using antidepressants today, according to a study published in Psychiatric Services. (See also Education Reporter, April 2004.) However, usage is far greater among teenagers. In 2002, nearly 6.4% of U.S. girls and 4.2% of boys aged 15 to 18 were taking antidepressants, the study found.

Australian researchers have concluded that pediatricians and family physicians should not prescribe antidepressants for depressed children and adolescents because the drugs barely work and their side effects are often significant. Five published trials of Prozac, Zoloft and Paxil found only a "very modest" benefit over placebos. The report appeared in the British medical journal BMJ on April 9. "What this shows is that, on balance, there is no good reason to prescribe these pills," said Dr. Joseph Glenmullen, author of Prozac Backlash. (New York Times, 4-9-04)

Second thoughts on vaccine? 
The latest child-vaccine controversy concerns the chickenpox vaccine, which is now required by schools in many states and is usually administered in a shot at 12 months of age. It is claimed that thousands of hospitalizations and nearly 100 lives per year are saved by the vaccine. However, about 10% of the vaccinated children are inadequately protected, and even among those who are well protected at first, the immunity tends to wear off over time. The March issue of Pediatrics reported a chickenpox outbreak in Portland, OR, where children who received the vaccine more than five years before the outbreak were nearly seven times as likely to contract the illness as those vaccinated in the previous five years.

"We are facing some of the quandaries that thoughtful opponents of this vaccine foresaw years ago," writes health columnist Jane Brody. Fading immunity could result in severe problems as the vaccinated population ages. Chickenpox symptoms tend to be far more severe in people older than 13, and women vaccinated as infants could contract chickenpox during pregnancy, possibly harming the fetus. (St. Louis Post-Dispatch, 4-5-04)

These potential serious consequences to vaccinated persons would not occur if they had instead acquired immunity by having the disease in childhood, because that immunity would generally not wear off. Having chickenpox is also believed to boost immunity to shingles, which tends to strike late in life. It is not yet known whether the vaccine offers the same benefit. (St. Louis Post-Dispatch, 1-27-04)

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